Carcinoid syndrome

Definition

Carcinoid syndrome is a group of symptoms associated with carcinoid tumors -- tumors of the small intestine, colon, appendix, and bronchial tubes in the lungs.

Causes, incidence, and risk factors

Carcinoid syndrome is the pattern of symptoms sometimes seen in people with carcinoid tumors. These tumors are rare, and often slow growing. About 70% of carcinoid tumors are found in the gastrointestinal tract.

Carcinoid syndrome occurs in about 1 in 10 people with carcinoid tumors, usually after the tumor has spread to the liver or lung.

These tumors release too much of the hormone serotonin, as well as several other chemicals that cause the blood vessels to open (dilate).

Symptoms

Most carcinoid tumors have no symptoms. When symptoms do occur, they may include:

Treatment

Surgery to remove the tumor is usually the first treatment. It can permanently cure the condition if the tumor is completely removed.

If the tumor has spread to the liver, treatment involves destroying the local blood supply of the tumor or giving chemotherapy directly into the liver.

When the entire tumor cannot be removed, removing large portions of the tumor ("debulking") can help relieve the symptoms.

Octreotide (Sandostatin) injections are sometimes given to people with advanced carcinoid tumors that cannot be removed with surgery. Interferon is often given with octreotide to help stop tumor growth. Patients whose carcinoid tumor secretes histamine will benefit from treatment with antihistamine drugs.

People with carcinoid syndrome should avoid alcohol, large meals, and foods high in tyramine (aged cheeses, avocado, many processed foods), because they may trigger symptoms.

Some common medicines, like selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and fluoxetine (Prozac), may make symptoms worse by increasing levels of serotonin. However, do not stop taking these medicines unless your doctor tells you to do so.

Support Groups

Expectations (prognosis)

The outlook in patients with carcinoid syndrome is different from the outlook in patients who have carcinoid tumors without the syndrome.

In people with the syndrome, the tumor has usually spread to the liver, which lowers the survival rate. People with carcinoid syndrome are also more likely to have a separate cancer (second primary tumor) at the same time.

The outlook is more favorable thanks to new treatment methods, such as Sandostatin.